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Antibiotics commonly overprescribed in elderly population

Despite clinical guidelines advising against the practice, nearly half of elderly patients presenting to a PCP for a nonbacterial acute upper respiratory infection were prescribed antibiotics, according to research published in Annals of Internal Medicine.

“Unnecessary antibiotic use is a major public health concern. It is associated with avoidable adverse drug events, increased health care costs, and emergence of antibiotic-resistant infections,” Michael Silverman, MD, from Schulich School of Medicine and Dentistry at St. Joseph’s Health Care in London, Ontario, Canada, and colleagues wrote.

“Targeted interventions to reduce inappropriate antibiotic prescribing require an understanding of the physician factors associated with this practice,” they added.

The researchers examined the prevalence and predictors of antibiotic prescribing in patients aged 66 years or older with nonbacterial acute upper respiratory infections (n = 185,014). Between January and December 2012, they conducted a retrospective analysis of linked administrative health care data from 8,990 PCPS in Ontario. To determine whether prescribing rates differed by physician characteristics, the researchers used a multivariable logistic regression model with generalized estimating equations.

Of the patients included, 53.4% had the common cold, 31.3% had acute bronchitis, 13.6% had acute sinusitis and 1.6% had acute laryngitis. The researchers excluded patients with cancer or immunosuppressive conditions and residents of long-term care homes.

Overall, results indicated that 46% of patients were prescribed an antibiotic, mainly broad-spectrum agents (69.9%; 95% CI, 69.6-70.2). Mid- to late-career physicians were more likely to prescribe antibiotics than early-career physicians (5.1 vs. 4.6 percentage points, respectively), as were physicians who saw 25 to 44 patients per day or 45 or more patients per day compared with those who saw fewer than 25 patients per day (3.1 vs. 4.1 percentage points, respectively). Patients were also more likely to receive an antibiotic prescription from physicians who were trained outside of the United States or Canada (3.6 percentage points)

“Targeted interventions aimed at changing established practice patterns and reducing physician pressures for high patient volumes may help reduce inappropriate antibiotic prescribing,” Silverman and colleagues concluded. – by Alaina Tedesco

Disclosure: The researchers report primary funding from the Ontario Ministry of Health and Long-term Care, Academic Medical Organization of Southwestern Ontario, Schulich School of Medicine and Dentistry, Western University and Lawson Health Research Institute.